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. 2020 Jun;80(6):646-655.
doi: 10.1016/j.jinf.2020.03.035. Epub 2020 Apr 8.

Serum Amyloid A is a biomarker of severe Coronavirus Disease and poor prognosis

Huan Li  1 , Xiaochen Xiang  2 , Hongwei Ren  1 , Lingli Xu  1 , Lisha Zhao  1 , Xiaoqiong Chen  1 , Hui Long  3 , Qiang Wang  4 , Qingming Wu  5
Affiliations

Serum Amyloid A is a biomarker of severe Coronavirus Disease and poor prognosis

Huan Li et al. J Infect. 2020 Jun.

Abstract

Background: To explore the significance of SAA in evaluating the severity and prognosis of COVID-19.

Methods: A total of 132 patients with confirmed COVID-19 who were admitted to a designated COVID-19 hospital in Wuhan, China from January 18, 2020 to February 26, 2020 were collected. The dynamic changes of blood SAA, CRP, PCT, WBC, Lymphocyte (L), PLT, CT imaging, and disease progression were studied. All patients completed at least twice laboratory data collection and clinical condition assessment at three time points indicated for this study; The length of hospital stay was longer than 14 days prior to February 26, 2020.

Results: COVID-19 patients had significantly increased SAA and CRP levels, while L count decreased, and PCT, WBC, and PLT were in the normal range. As disease progressed from mild to critically severe, SAA and CRP gradually increased, while L decreased, and PLT, WBC, and PCT had no significant changes; ROC curve analysis suggests that SAA/L, CRP, SAA, and L count are valuable in evaluating the severity of COVID-19 and distinguishing critically ill patients from mild ones; Patients with SAA consistently trending down during the course of disease have better prognosis, compared with the patients with SAA continuously rising; The initial SAA level is positively correlated with the dynamic changes of the serial CT scans. Patient with higher initial SAA level are more likely to have poor CT imaging.

Conclusions: SAA and L are sensitive indicators in evaluating the severity and prognosis of COVID-19. Monitoring dynamic changes of SAA, combined with CT imaging could be valuable in diagnosis and treatment of COVID-19.

Keywords: C-reactive protein; Computed tomography imaging; Coronavirus Disease 2019; Lymphocyte; Serum amyloid A; Severity.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

Figures

Fig. 1
Fig 1
SAA/L and clinical classification.
Fig. 2
Fig 2
SAA/L,CRP,SAA,L and clinical classification.
Fig. 3
Fig 3
Relationship between SAA2/L2, SAA2, CRP2, L2 and the progression of disease.
Fig. 4
Fig 4
Relationship between SAA, CRP, L, SAA/L dynamics and the progression of disease.
Fig. 5
Fig 5
The correlation of SAA, CRP, L and SAA/L dynamics and patient outcome.
Fig. 6
Fig 6
(64 year-old male patient, febrile and cough for 2 days): serial CT scans and SAA dynamic changes. Typical serial CT scans and SAA dynamic changes.
Fig. 7
Fig 7
(84 year-old male patient, febrile, hacking cough, short of breath for three days): serial CT scans and SAA dynamics, the first CT scan was mild, but SAA was more than 200 mg/L, and maintained at a high level, which suggest poor prognosis, the later two CT images showed severe (the patient died 21 days later after admission). Typical serial CT scans and SAA dynamic changes.
See this image and copyright information in PMC

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